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Advances in laser cataract surgery technology enhance ease, effectiveness of procedure
A surgeon discusses the features of Catalys, its low learning curve and how to integrate the system into practice.
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The field of cataract surgery is in the midst of a revolutionary change with the advent of laser cataract surgery technology. While first introduced commercially in 2009, the field has evolved recently with new surgical technology designed to improve upon first-generation systems.
In April, Cleveland Eye Clinic became the third practice in the United States to purchase and install the Catalys Precision Laser System (OptiMedica), a new laser cataract surgery platform that was cleared by the U.S. Food and Drug Administration in December 2011. We believe that our experience in integrating and using Catalys may be instructive to other surgeons who are currently considering adopting laser cataract surgery technology in their practices.
As of publication time, we have performed about 400 cases with Catalys. I have performed more than 200 of these cases. Our experience with the Catalys laser has been positive. The system has a low learning curve, requiring only three or four cases to achieve mastery of the procedure. Catalys is easy on both surgeon and patient, and it is effective at what it is designed to do. Patients are embracing the technology, as evidenced by our conversion rate of 30% to 35%. These findings have convinced us that laser cataract surgery will eventually become a centerpiece of the advanced cataract practice.
Laser cataract surgery
Treatments with Catalys are pre-planned using template-based software. The touch screen graphical user interface is intuitive and makes working with the system easy from the start.
The template-based software allows the surgeon to choose different options for the capsulotomy centration. I choose to center my capsulotomies on the center of the lens capsule, a capability that is unique to Catalys. This centration option helps ensure that, when the IOL is in place, it is properly centered within the capsulotomy itself. I believe that if you are able to center the capsulotomy perfectly on the implant, it will help determine the effective lens position of the implant and, in turn, help the overall refractive accuracy of the procedure.
Catalys also allows the surgeon to choose from different lens segmentation grids. I prefer to divide the cataract in quadrants with lens softening in cubes, another feature unique to Catalys. For most cataracts, I soften with 500-µm cubes, but for denser cataracts, I provide additional softening with 350-µm cubes.
Shamik Bafna
With the treatment already pre-planned, patients are stabilized to the system with a fluid-filled Liquid Optics interface that makes docking easy for both surgeon and patient. The interface also keeps IOP low (average IOP rise during the procedure is 15 mm Hg), which enhances patient comfort. Most patients have commented that they have had no discomfort during the procedure.
Next, the Catalys system’s unique 3-D optical coherence tomography technology images the eye extremely well, accounting for tilt of the lens and correctly identifying all of the intraocular structures. Sophisticated algorithms are then applied to the image to automatically customize treatment and ensure the laser is precisely delivered. I have found cataract surgery with Catalys to be more accurate and reproducible because of its 3-D OCT and automatic treatment customization capability.
Treatment with Catalys is precise. Our capsulotomies are free floating, and emulsification and softening of the lens are so effective that we can significantly reduce the amount of ultrasound required. We have found we have an average reduction of phaco power of 70% on grades 3 and 4 cataracts, making treatment of dense cataracts a more straightforward procedure. For grades 1 to 2+, we frequently can emulsify without phaco power because Catalys has essentially pre-chopped the cataract and softened the pieces.
In my experience treating patients with Catalys, two things have surprised me: how easy the system is to use and how effective it is at softening the cataract. I thought it would help break up the cataract, but what fascinates me is how much easier it is when compared with manual surgery. There are days that I perform several Catalys procedures followed by regular cataract surgeries in which I use just ultrasound. After I have completed a few Catalys procedures, it seems the traditional procedures are more difficult than they should be.
Integration into practice
There are two factors to system integration when it comes to staff. One factor is within the clinic and having surgery counselors who are able to explain the technology to patients. The other is how to incorporate the laser into the surgery center in a way that does not slow down the efficiency of the procedure.
We have found that our surgery counselors have been able to incorporate Catalys quite easily into their discussions with patients. We were already offering premium implants, so surgery with Catalys just became another advanced technology option we were making available to patients.
In the surgery center, we decided to place Catalys in a room outside of the operating room. We are typically one patient ahead in the sense that there is one patient in the operating room while I am performing a procedure with Catalys. Following the Catalys procedure, I will do the surgery on the previous patient while they bring the Catalys patient back to the operating room. Then I will finish up with cataract removal and lens replacement for that patient. It took a few sessions to determine how to make the flow efficient, but currently our actual laser time is about 3 minutes, and the additional time transporting the patient is not very noticeable due to our parallel staging.
Patient conversion
We were initially concerned that, because there is a higher cost involved, conversion would be somewhat of a challenge. However, we have seen that patients appreciate what the laser represents and how Catalys is able to improve the accuracy and reproducibility of the procedure. I am finding that about 35% of my patients are deciding to utilize the laser to try to improve their overall refractive outcomes. When they understand the differences between laser cataract surgery and traditional surgery, they tend to gravitate toward the laser.
Pearls for system research, practice planning
- All laser cataract surgery systems are not the same. Do your homework by trying or observing the commercially available systems in your colleagues’ practices. The differences become even more evident upon observation and use than they do when you just hear or read about the technology.
- Develop an economic plan. It is reasonable to assume that a conversion rate of 300 to 400 patients per year will cover the cost of the laser.
- Get off the sidelines. If you want to be on the leading edge as far as technology is concerned, I believe you need to adopt laser cataract surgery, given the revolutionary change it is driving in the field.